Physician Author and Medical Writer

Recent Newspaper & Online Columns by Kate Scannell MD

By Dr. Kate Scannell, Syndicated columnist
First published in print: 08/24/2014

Nearly everyone at the table last week had a personal story to tell about Robin Williams. That surprised me a little, because this gathering of friends was so diverse -- and so Oakland. One person talked about Williams coming over to shake hands with her then-young son who, awestruck and shy, had spotted Williams from afar at a local museum. Another recalled the time Williams broke away from some assembly to help our cane-dependent friend -- yes --- cross the street. A psychotherapist said that most of her clients had talked about Williams' death throughout the week with sadness and affection. And I relayed my story of meeting Williams and his family on a beach many years ago -- they could not have been friendlier to me.

After Robin Williams died on Aug. 11, it was remarkable to see how much of the public's reaction reflected gratitude for his body of work and a deep appreciation of his personal attributes -- his generosity, soulfulness and kindness. That's not how our society always responds to the deaths of major public figures.

I know nothing of Williams' medical conditions beyond what's been reported in the media. And I don't pretend to understand why he committed suicide. But Williams' death casts a light on the public psyche, illuminating darkness familiar to many of us. And it emphatically reminds us that we do not always see how people actually struggle in the shadows.

As a physician, I'm also reminded that the difficulty of coping with multiple inter-related illnesses is often under-estimated. For example, it's generally challenging enough to suffer any one of the illnesses Williams reportedly faced -- drug and alcohol addiction, major depression, and Parkinson Disease. But someone who simultaneously suffers all three also tends to suffer the additional burden of their mutually affecting relationships. That is, he suffers knowing that changes in the status of one illness could easily offset control of the others. That medications used to help one disorder could worsen regulation of another.

The complexity of balancing such mutually affecting conditions should be considered as another "medical condition" altogether. The balancing act can demand greater energy and attention from a patient and his doctor than what's summarily required by the management of the individual medical illnesses. When we don't recognize this, we don't fully recognize the scope and depth of a patient's struggle.

Unfortunately, health care today does not always recognize or accommodate this condition of complexity. It may readily provide a patient with a dozen guidelines to follow for their dozen medical conditions, all the while losing track of the patient as one unitary being. It may refer a patient to six specialists who focus on six separate medical problems, all the while leaving the patient alone with his beleaguered primary care doctor, trying to find the so-called balance.

Obviously, such piecemeal diagnosis and treatment can harm patients who require coordinated care for healthy equilibrium of complex medical problems. In a less obvious but important way, such fragmented care can also harm patients by denying them a coherent understanding of their distress, generating experiences of frustration or hopelessness.

When health providers don't carefully connect the dots between someone's multiple illnesses and treatments, patients can be left without a unified sense of their bodies and minds. Patients who are not seen within the wholeness of their experiences of suffering are people rendered invisible.

Williams famously saw connections in the world that could at once surprise and delight us. Within seconds, he could verbally riff his way from a pink scarf in Los Angeles, to a movie director in Bombay, to an iron chef busily preparing octopus. He could connect the dots between a platypus and king. And in demonstrating dynamic connections everywhere, he had a genius for making people feel more connected to each other.

Given this talent of his, and given what I've learned from patients struggling to live with complex conditions, I've been resisting media speculations that attribute Williams' suicide to some singular, isolated medical or external cause. To an enduring battle with drug and alcohol addiction. Ongoing struggles with major depression. The sequella of heart disease. A dark outlook about the future after being diagnosed with Parkinson Disease. Or, as one of his friends alleged, medication side effects.

I understand the appeal of seeking "a reason" when someone commits suicide. It allows what is senseless to many people to become reason-able. By establishing a cause, intervention becomes logical and possible. But holding onto a reason can sometimes make us complacent, so that we don't look further for additional understanding. And we end up missing the bigger picture, the one that wholly mattered to the person who died.

Journalist Rebecca Skloot’s new book is a gripping read that embodies all abstractions about research ethics in a compelling tale about Henrietta Lacks – a woman whose microscopic cancerous cells shook the world’s medical establishment in 1951.